[Question #4429] FAO Dr Hook/Hunter - HIV from secretions to Cuts, ARS!

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81 months ago
Dr Drs

14 days ago I cut finger with thick foil from medication blister pack. 5mm & deep enough to bleed. Put plaster put.

20 hours later in Thailand had massage. I refused offer of sex (CSW maybe high risk?). I vigorously rub her clit & vagina opening; was very wet. Dont remember fingering. She gave handjob - her hands wet ?vaginal fluids. At home remembered I used cut finger. I had removed plaster hours before massage as no bleeding. I squeezed finger & no bleeding but red area size of a full stop at base of cut (not scab).

Few days later had handjob from ladyboy/& a CSW with mutual nipple sucking with the latter. No penetrative/oral sex.

12 days after the initial encounter felt nausea followed by fatigue, arthralgia/myalgia. Now 3 days & still fatigue/myalgia, nausea & intermittent epigastric/umbilical discomfort. I have mild sore throat 1-2 days with a minor stuffy nose. 1 episode loose stool today. No fever though felt chilly yesterday. 2 itchy spots on hand but no body rash. Feel weak colleagues said i look unwell.

Im aware mutual masterbation is low risk. However  worried that vaginal secretions/HIV entered my day old cut.

As a healthcare worker Im confident that my symptoms are not due to anxiety. It may be a virus I picked up on my travels but Im struggling not to conclude that I'm having ARS symptoms due to HIV from initial encounter.

Please comment on my risk & situation. Could I be the 1st to be infected like this - punishment from higher being? 
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Edward W. Hook M.D.
81 months ago
Welcome to the forum and thanks for your question.  I'll be glad to comment.  Your recent symptoms following the cut you experienced are coincidental and not due to HIV or any other illness you might have acquired during your interactions you describe with the CSWs.  When cuts such as the one you describe occur they begin to seal up almost immediately, preventing access of microbes from the environment from access your blood stream.  If either of the CSWs you interacted with had HIV (still unlikely from a statistical perspective), their virus would not have accessed your blood stream to cause infection.  These are no risk exposures which are not medical indications for concern or for HIV testing.  

As you point out, as travelers it is quite common to pick up circulating viruses.  I suspect that is what has happened.  You are not going to be the first person to acquire HIV form these sorts of exposures.  EWH
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81 months ago
Thank you for your reply, it is reassuring.

To follow on,
1 - regarding HIV in vaginal secretions - is their a difference between fingering and external masturbation of a female partner?
2 - on a popular website it claims there are no HIV particles in lubricating fluids released from bartholins glands during masturbation of a female partner.
3 - why cant HIV particles be forced into the wound with severe vigorous rubbing?
4 - what kind of wounds would be susceptible, a popular website states even a freshly  amputated finger inserted into a HIV persons vagina would not be a significant risk?
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Edward W. Hook M.D.
81 months ago
I think you are over-thinking this
1. No, the risk of exposure (none) is comparable whether the exposure takes place inside a partner's vaginal or due to external contact.
2.  "Popular websites" and the internet in general are a notorious source of misinformation.  I know of no credible data to suggest that secretions from a Batholin;s gland would not be infectious.
3.  There are multiple factors in play here including that the blood vessel integrity which prevents bleeding also prevents access, that when bleedin occurs, the flow is out, not inward, and finally, the environmental exposure eliminates infectivity virtually immediately.
4.  None that I am aware of.  The person involved in the fanciful situation you mention would have more to worry about than masturbating  partner.

My advice to you is to stay off the internet and to not worry about the events you describe.  You are not going to be the 1rst person to acquire HIV form a paper cut  EWH
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81 months ago
Thank you for your response.
This will be my final post. To confirm my understanding of your responses.

1 - A cut on a finger involving foil from a medication blister pack is still classified as a 'paper cut' even though it is thicker and even if bleeding occurred.
2 - Such 'paper cuts' if actively bleeding or not do not allow transmission of HIV particles as if bleeding particles cannot get in and if not bleeding then are sealed. 
3 - The wounds that let the infection in would be large open wounds such as RTA trauma or medical procedures.
4 - My feeling nauseous and aching is not ARS but a coincidence.
5 - You don't thin testing is required - note i am in a long term relationship.
6 - Finally how does a needlestick injury transmit HIV if it superficial yet cuts cannot.

Thanks in advance for your final post.

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Edward W. Hook M.D.
81 months ago
1.  Correct
2.  Correct
3.  Even "large open wounds" rarely, if ever lead to infection.
4.  Correct
5.  Correct, I see no need for testing.
6.  Sigh.  Needlesticks directly introduce blood contained within the lumen of a hollow needle deep into tissue where there can be access to the blood stream.  In such instance, the risk for infection is calculated to be 0.3% (i.e. less than 1 infection per 300) for needle sticks, if the person was HIV infected and not on effective therapy.  

As you point out, as per Forum guidelines, this will be the final response as part of this thread.  I hope the information I have provided will be helpful to you.  Please do not worry.  EWH
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